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IGeL: Your Guide to Costs & Reimbursement in GKV and PKV

The German healthcare system guarantees comprehensive basic medical care. However, in doctors' practices, patients are often offered services that their health insurance does not cover as standard. These are Individual Health Services, or IGeL for short.

This guide explains exactly what IGeL are, highlights the fundamental differences in cost coverage by Statutory Health Insurance (GKV) and Private Health Insurance (PKV), and provides you with a well-founded decision-making aid.

What exactly are Individual Health Services (IGeL)?

To understand the concept of IGeL, a look at the two pillars of the German healthcare system is essential:

Statutory Health Insurance (GKV): It operates on the principle of solidarity. Services are defined in Social Code Book V (SGB V) and must adhere to the principle of economic efficiency – they must be „sufficient, appropriate, and economical.“ The GKV service catalog is binding for all insured persons.
Private Health Insurance (PKV): It is based on the equivalence principle. The scope of services is individually determined in the insurance tariff and is contractually guaranteed. Contributions are based on the tariff, age, and health status at the time of contract conclusion.

IGeL are precisely situated in the gap between standard GKV care and individual patient wishes. These are medical, diagnostic, or preventive services that are not part of the GKV service catalog. GKV-insured individuals must therefore pay for them privately if they wish to use them. In PKV, the term „IGeL“ does not formally exist; here, a distinction is merely made between services covered by the tariff and those not covered.

Typical IGeL Services: From Prevention to Comfort

IGeL offers often include preventive or service benefits whose medical utility has been deemed not strictly necessary by the Federal Joint Committee (G-BA) or has not yet been conclusively positively evaluated. Here are common examples:

Extended Prevention:
- Additional ultrasound examinations during pregnancy
- Glaucoma early detection (measurement of intraocular pressure)
- Special blood tests for cancer early detection (e.g., PSA test for prostate cancer)
Vision Aids and Eye Corrections:
- Glasses and contact lenses for adults (except for severe visual impairments)
- Eye laser treatments like LASIK
Dentistry:
- Professional dental cleaning
- High-quality dental prostheses, e.g., implants instead of standard care (bridge)
Alternative Healing Methods:
- Osteopathy or acupuncture (outside GKV-recognized indications)
- Treatments by alternative practitioners
Comfort and Service Benefits:
- Medical certificates for sports clubs or travel
- Travel vaccination consultations

Cost Coverage for IGeL: GKV vs. PKV in Direct Comparison

The handling of services outside the GKV catalog fundamentally differs between the two systems.

Situation for GKV-Insured Individuals

For those with statutory insurance: IGeL services must be paid for entirely out of pocket. The doctor is legally obligated to fully inform you about the costs incurred before treatment and to conclude a written treatment agreement with you.

Important: This is not to be confused with statutory co-payments. Co-payments (e.g., for medications or hospital stays) apply to services within the GKV catalog and are legally limited to 2% of the annual gross income (1% for chronically ill individuals).

A private supplementary insurance can be a sensible addition to specifically close coverage gaps for IGeL that are personally important to you (e.g., for dental prostheses, glasses, or alternative practitioners).

Situation for PKV-Insured Individuals

Whether a service considered an IGeL in the GKV is reimbursed by the PKV depends exclusively on the chosen tariff. A PKV contract precisely defines the scope of services. Many of the IGeL mentioned above can – depending on the tariff – be fully or partially reimbursed.

Reimbursement Principle: You receive an invoice from the doctor and submit it to your insurance, which reimburses you for the costs according to your tariff.
Premium Reimbursement (BRE): Many tariffs offer a premium reimbursement if you do not submit any invoices for a year. This provides an incentive to bear smaller invoices (which could be considered IGeL) yourself to secure a high reimbursement.

[Image: Infographic comparing IGeL cost coverage in GKV and PKV]alt="Comparison graphic showing how IGeL services are handled in GKV and PKV"

Decision Aid: When Are IGeL Services Useful for You?

The decision for or against an IGeL should always be made well-informed.

For GKV-Insured Individuals:

Question the benefit: Inform yourself about the medical benefit, e.g., on the independent "IGeL-Monitor" of the Medical Service.
Check for alternatives: Ask your doctor if a comparable treatment exists that is covered by the GKV.
Consider supplementary insurance: If certain services are important to you, consider taking out private supplementary insurance.

For PKV-Insured Individuals (and those interested in switching):

Carefully check tariff details: Do not assume that "privately insured" automatically means "everything covered." The scope of services varies greatly.
Weigh costs and benefits: A more comprehensive tariff is more expensive. Consider which services are worth a higher premium to you and perform a tariff comparison.

Conclusion

Individual Health Services (IGeL) are privately payable services for GKV-insured individuals that go beyond the statutory standard. In contrast, for PKV, the chosen tariff alone determines cost reimbursement. A conscious decision, based on a careful consideration of benefits, necessity, and costs, is the key to optimal healthcare for insured individuals in both systems.

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